Anaesthetic Consideration in Mucormycosis Patients Posted for RhinoOrbital-Dental Surgeries

Background: Multiple considerations exist for the anesthesiologists in covid-19 recovered patients with added problems arising due to rhino-orbital-cerebral mucormycosis and adverse effects of antifungal drugs. Overall morbidity and mortality are more in such patients. Managing such patients posted for surgical debridement presents a unique challenge to the anesthesiologist. Methods: A retrospective analysis of 118 patients operated for surgical debridement and histopathology confirmed mucormycosis cases were analysed from the medical record. A review of preoperative clinical and laboratory data, intraoperative anaesthesia details and postoperative outcome was done. Results: 118 confirmed mucormycosis patients were analysed. 98 patients tested covid positive, out of which 73 were hospitalized. 101 patients presented with diabetes mellitus. 53 patients were operated after 8 weeks of corona virus infection. 41 patients had increased creatinine levels. 7 patients presented with difficult intubation. Intraoperatively anesthesia concerns were tachycardia, hypertension, tachycardia combined with hypotension, arrythmias, hyperglycemia, raised end tidal carbon dioxide concentration (ETCO2), increased peak airway pressure and oozing in various patients. All patients were extubated. Postoperatively, 15 patients required oxygen, 92 were discharged and death resulted in 9 patients. Conclusion: Knowledge of disease, preoperative optimization and proper preparation of patients and postoperative icu care is must for successful management of mucormycosis patients undergoing surgical debridement.